Dr. John Michael Domanico, DDS
Dentist, Oral and Maxillofacial Surgery in Chicago, IL. Individual provider (NPI-1).
NPI number1962500348
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1962500348
- Entity type
- Individual (NPI-1)
- Name
- Dr. John Michael Domanico
- Credential
- DDS
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Sep 20, 2006
- Last updated
- Jul 8, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223S0112X | Dentist, Oral and Maxillofacial Surgery | 019018098 | IL | Yes |
Practice location
30 N Michigan AveSuite 522
Chicago, IL 60602-3402
Phone 312-629-3530
Mailing address
30 N Michigan AveSuite 522
Chicago, IL 60602-3402
Phone 312-629-3530
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